The Effect of Rigid Cervical Collar Height on Full, Active, and Functional Range of Motion During Fifteen Activities of Daily Living
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Laboratory biomechanical experiment.To evaluate how different anterior cervical collar heights restrict full, active range of motion (ROM), and functional ROM during 15 activities of daily living.Hard cervical collars are commonly used in the clinical setting. Collar fit is presumed to affect immobilization, making neck height an important variable. No prior study has evaluated how different collar heights affect full, active and functional ROM.A previously validated electrogoniometer device was employed to quantify both full, active, and functional ROM. For each of 10 subjects, these ROM measurements were repeated without a collar and with an adjustable, hard collar (Aspen Vista) at each of 6 collar neck height settings.For each increase in collar height, there was a corresponding decrease in mean full, active ROM of 3.7% (3°) in the sagittal plane (R2 = 0.91, P = 0.003), 3.9% (3°) in the coronal plane (R2 = 0.88, P = 0.005), and 2.8% (4°) in the rotational plane (R2 = 0.86, P = 0.006). For each increase in collar height, there was a corresponding decrease in mean functional ROM across all of the tested activities of daily living of 1.1% (1°) in the sagittal plane (R2 = 0.90, P = 0.004), 0.4% (0.4°) in the coronal plane (R2 = 0.86, P = 0.007), and 0.6% (0.5°) in the rotational plane (R2 = 0.81, P = 0.014). For each increase in collar height, there was a 1.7° increase in mean neck extension while in the neutral position (R2 = 0.99, P < 0.001).This study suggests that greater cervical collar height for hard cervical collars will better restrict full, active, and functional cervical ROM. However, the change in functional ROM was only about one quarter to that of full active ROM and the clinical significance of this may be questioned. This must be balanced by the fact that this increased collar height forces the neck into greater extension which may not be the most clinical desired or functional position and may cause skin-related issues at the jaw or chest.Keywords:
Collar
Cervical collar
Laboratory biomechanical experiment.To evaluate how different anterior cervical collar heights restrict full, active range of motion (ROM), and functional ROM during 15 activities of daily living.Hard cervical collars are commonly used in the clinical setting. Collar fit is presumed to affect immobilization, making neck height an important variable. No prior study has evaluated how different collar heights affect full, active and functional ROM.A previously validated electrogoniometer device was employed to quantify both full, active, and functional ROM. For each of 10 subjects, these ROM measurements were repeated without a collar and with an adjustable, hard collar (Aspen Vista) at each of 6 collar neck height settings.For each increase in collar height, there was a corresponding decrease in mean full, active ROM of 3.7% (3°) in the sagittal plane (R2 = 0.91, P = 0.003), 3.9% (3°) in the coronal plane (R2 = 0.88, P = 0.005), and 2.8% (4°) in the rotational plane (R2 = 0.86, P = 0.006). For each increase in collar height, there was a corresponding decrease in mean functional ROM across all of the tested activities of daily living of 1.1% (1°) in the sagittal plane (R2 = 0.90, P = 0.004), 0.4% (0.4°) in the coronal plane (R2 = 0.86, P = 0.007), and 0.6% (0.5°) in the rotational plane (R2 = 0.81, P = 0.014). For each increase in collar height, there was a 1.7° increase in mean neck extension while in the neutral position (R2 = 0.99, P < 0.001).This study suggests that greater cervical collar height for hard cervical collars will better restrict full, active, and functional cervical ROM. However, the change in functional ROM was only about one quarter to that of full active ROM and the clinical significance of this may be questioned. This must be balanced by the fact that this increased collar height forces the neck into greater extension which may not be the most clinical desired or functional position and may cause skin-related issues at the jaw or chest.
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Background: Various types of cervical collars have being used to immobilize the cervical spine. There was no information regarding the effectiveness of Cervicothoracic collars (Minerva) on restriction of motions in cervical spine. Therefore, the purpose of this study was to evaluate the immobilization achieved follow the use of Minerva collar in cervical and Cervicothoracic spine. Methods: Twenty healthy subjects (10 females and 10 males) were recruited in the study with no history of pain, deformity and surgery in spine. A motion analysis system was used to record the motions of cervical, upper thoracic and cervicothoracic in flexion, extension, lateral bending and rotation with and without Minerva collar. Results: The motion restriction of the upper cervical spine obtained with Minerva collar varied between 86.32 and 90%. The range of flexion/extension of cervical and cervicothoracic parts decreased by 27.35 and 56.32%, respectively follow the use of Minerva collar. The flexion/ extension range of motion of this segment decreased by 77.85 and 63.25%, respectively between occiput and T12. Conclusion : The maximum restriction of motion with Minerva collar was achieved in cervical spine. Due to the efficiency of Minerva collar to restrict the motions of cervical, especially in the upper part.
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Objective To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine movement in the sagittal, coronal and axial planes. Methods Nineteen healthy volunteers (12 female, 7 male) were recruited to the study. Collars were fitted by an approved physiotherapist. Eight ProReflex (Qualisys, Sweden) infra-red cameras were used to track the movement of retro reflective marker clusters placed in predetermined positions on the head and trunk. 3D kinematic data was collected during forward flexion, extension, lateral bending and axial rotation from uncollared and collared subjects. The physiological range of motion in the three planes was analysed using the Qualisys Track Manager system. Results The Aspen and Philadelphia collars were found to be significantly more effective at restricting movement in the sagittal plane compared to the Vista (p Conclusion The Aspen collar was found to be superior to the other collars when measuring restriction of movement of the cervical spine in all planes, particularly the sagittal and transverse planes, while the Aspen Vista was the least effective collar.
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Study objective To determine whether semirigid cervical collars eliminate cervical spine (CS) flexion in children on back boards. Design Prospective clinical study Setting An urban pediatric emergency department. Participants Eighteen head-injured children <8 years of age undergoing CS radiographs. Interventions Children were secured to back boards, and semirigid cervical collars were applied. Following CS clearance, the collar was removed, and an additional lateral film without collar was obtained. C2-C6 lateral Cobb angles were measured on both lateral films. Main results Mean flexion with collar was 3.4 \pm 9.9 degrees and 5.6 \pm 6.8 degrees without a collar P > 0.05 Conclusion Most children <8 years, when immobilized on back boards have flexed CSs. Semirigid cervical collars do not eliminate flexion. Further study is needed to develop and test different methods of CS immobilization as present equipment is unable to position the CS optimally.
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Clinicians recommend soft cervical collars to immobilize the cervical spine following trauma. They apply them either as intended by the manufacturer or reversed (collar rotated 180 degrees), purportedly to achieve limitation in a specific direction. This study investigated the effectiveness of soft cervical collars in limiting cervical range of motion when worn as recommended or reversed. All planes of cervical range of motion of 50 volunteer subjects without current or past cervical dysfunction were measured under three conditions (no collar, recommended use, and reversed) using the Orthopedic Systems Inc. Computerized Anatometry-6000 Spine Motion Analyzer. The instrument has been previously shown to produce measures with high reliability and to correlate strongly with known angular measures. Within subjects analyses of variance indicated significant differences in all six ranges of motions among the three conditions. Post hoc paired t tests showed that wearing a collar either as recommended or reversed decreased motion compared with not wearing a collar, and that the position of the collar affected range of motion in three of the six motions. Differences in range can be attributed to location of the collar closure and initial head posture. Soft cervical collars can physically limit motion when worn either way.
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The aim of this study was to compare the remaining motion of an immobilized cervical spine using an innovative cervical collar as well as two traditional cervical collars. The study was performed on eight fresh human cadavers. The cervical spine was immobilized with one innovative (Lubo Airway Collar) and two traditional cervical collars (Stifneck and Perfit ACE). The flexion and lateral bending of the cervical spine were measured using a wireless motion tracker (Xsens). With the Weinman Lubo Airway Collar attached, the mean remaining flexion was 20.0 ± 9.0°. The mean remaining flexion was lowest with the Laerdal Stifneck (13.1 ± 6.6°) or Ambu Perfit ACE (10.8 ± 5.8°) applied. Compared to that of the innovative Weinmann Lubo Airway Collar, the remaining cervical spine flexion was significantly decreased with the Ambu Perfit ACE. There was no significant difference in lateral bending between the three examined collars. The most effective immobilization of the cervical spine was achieved when traditional cervical collars were implemented. However, all tested cervical collars showed remaining motion of the cervical spine. Thus, alternative immobilization techniques should be considered.
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All multi‐trauma patients with suspected cervical spine injury should have their cervical spine protected while other life‐threatening injuries are being managed. The application of a hard cervical collar is an acceptable method of temporarily immobilizing the cervical spine. Two cases of significant occipital pressure ulceration associated with the use of hard cervical collar are presented.
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